Leanne Brown

Profile of the rural allied health workforce in Northern New South Wales and comparison with previous studies

OBJECTIVE To survey allied health professionals in one region of New South Wales. DESIGN A questionnaire designed to give a profile of the allied health workforce was mailed to 451 practitioners from 12 health professions between July and September 2005. SETTING The region included the upper Hunter Valley, Liverpool Plains, New England Tablelands and North-west Slopes and Plains of New South Wales. MAIN OUTCOME MEASURES The overall response was 49.8%, although the response rates varied between disciplines. Data were collected for a wide range of dependent variables. RESULTS Pharmacists were the most numerous respondents (21.8%), followed by physiotherapists (17.3%), psychologists (12.4%), radiographers (11.1%) and occupational therapists (10.6%). These five professions made up 73.3% of respondents. Approximately 75% of the sample worked in Rural, Remote and Metropolitan Areas (RRMA) 3 and 4 sized towns. The female to male ratio was 3:1. The mean age was 43 years, the average time since qualification was 20 years and the mean time in the current position was 10 years. Half of the respondents said they intended leaving within 5 years. Some 65% were of rural origin. The ratio of private to public sector employment was 0.75:1, with 64.0% working full-time. CONCLUSIONS Comparison is made between this and previous studies. The results highlight the need for further regional allied health workforce profiling and for a recruitment and retention strategy that targets new graduates of rural origin and encourages them to stay.

Evaluating interprofessional learning modules: health students’ attitudes to interprofessional practice

Abstract Interprofessional learning opportunities are thought to assist health students to work in a more collaborative, patient focussed manner during their career. In line with this thinking, the University of Newcastle’s Department of Rural Health delivers monthly interprofessional learning modules (ILMs) to students on a range of health topics. Students’ attitudes towards interprofessional learning were assessed pre- and post-ILM, using the Readiness for Interprofessional Learning scale (RIPLS). Thirty-eight students completed both pre- and post-surveys with a return rate of 36%. Our results demonstrated a statistically significant improvement in students’ attitudes to interprofessional learning in three of four domains. Based on the findings from this study, ILMs appear to be a worthwhile educational opportunity and may improve student attitudes to interprofessional learning in the short term.

Diet Quality and Cancer Outcomes in Adults: A Systematic Review of Epidemiological Studies

Dietary patterns influence cancer risk. However, systematic reviews have not evaluated relationships between a priori defined diet quality scores and adult cancer risk and mortality. The aims of this systematic review are to (1) describe diet quality scores used in cohort or cross-sectional research examining cancer outcomes; and (2) describe associations between diet quality scores and cancer risk and mortality. The protocol was registered in Prospero, and a systematic search using six electronic databases was conducted through to December 2014. Records were assessed for inclusion by two independent reviewers, and quality was evaluated using a validated tool. Sixty-four studies met inclusion criteria from which 55 different diet quality scores were identified. Of the 35 studies investigating diet quality and cancer risk, 60% (n = 21) found a positive relationship. Results suggest no relationship between diet quality scores and overall cancer risk. Inverse associations were found for diet quality scores and risk of postmenopausal breast, colorectal, head, and neck cancer. No consistent relationships between diet quality scores and cancer mortality were found. Diet quality appears to be related to site-specific adult cancer risk. The relationship with cancer mortality is less conclusive, suggesting additional factors impact overall cancer survival. Development of a cancer-specific diet quality score for application in prospective epidemiology and in public health is warranted.

Validation of a Smartphone Image-Based Dietary Assessment Method for Pregnant Women

Image-based dietary records could lower participant burden associated with traditional prospective methods of dietary assessment. They have been used in children, adolescents and adults, but have not been evaluated in pregnant women. The current study evaluated relative validity of the DietBytes image-based dietary assessment method for assessing energy and nutrient intakes. Pregnant women collected image-based dietary records (via a smartphone application) of all food, drinks and supplements consumed over three non-consecutive days. Intakes from the image-based method were compared to intakes collected from three 24-h recalls, taken on random days; once per week, in the weeks following the image-based record. Data were analyzed using nutrient analysis software. Agreement between methods was ascertained using Pearson correlations and Bland-Altman plots. Twenty-five women (27 recruited, one withdrew, one incomplete), median age 29 years, 15 primiparas, eight Aboriginal Australians, completed image-based records for analysis. Significant correlations between the two methods were observed for energy, macronutrients and fiber (r = 0.58–0.84, all p < 0.05), and for micronutrients both including (r = 0.47–0.94, all p < 0.05) and excluding (r = 0.40–0.85, all p < 0.05) supplements in the analysis. Bland-Altman plots confirmed acceptable agreement with no systematic bias. The DietBytes method demonstrated acceptable relative validity for assessment of nutrient intakes of pregnant women.

A cohort of Indigenous Australian women and their children through pregnancy and beyond: the Gomeroi gaaynggal study.

Indigenous Australians have high rates of chronic diseases, the causes of which are complex and include social and environmental determinants. Early experiences in utero may also predispose to later-life disease development. The Gomeroi gaaynggal study was established to explore intrauterine origins of renal disease, diabetes and growth in order to inform the development of health programmes for Indigenous Australian women and children. Pregnant women are recruited from antenatal clinics in Tamworth, Newcastle and Walgett, New South Wales, Australia, by Indigenous research assistants. Measures are collected at three time points in pregnancy and from women and their children at up to eight time points in the childs first 5 years. Measures of fetal renal development and function include ultrasound and biochemical biomarkers. Dietary intake, infant feeding and anthropometric measurements are collected. Standardized procedures and validated tools are used where available. Since 2010 the study has recruited over 230 women, and retained 66 postpartum. Recruitment is ongoing, and Gomeroi gaaynggal is currently the largest Indigenous pregnancy-through-early-childhood cohort internationally. Baseline median gestational age was 39.1 weeks (31.5-43.2, n=110), median birth weight was 3180 g (910-5430 g, n=110). Over one third (39.3%) of infants were admitted to special care or neonatal nursery. Nearly half of mothers (47.5%) reported tobacco smoking during pregnancy. Results of the study will contribute to knowledge about origins of chronic disease in Indigenous Australians and nutrition and growth of women and their offspring during pregnancy and postpartum. Study strengths include employment and capacity-building of Indigenous staff and the complementary ArtsHealth programme.

Private practice in rural areas: an untapped opportunity for dietitians.

OBJECTIVE The purpose of this study was to describe the current demography of rural dietetic private practice and to determine the drivers and barriers for further development. DESIGN A sequential explanatory mixed methods approach was used. Document searches and semistructured in-depth individual interviews were used to collect quantitative and qualitative data. SETTING Six rural case study sites of dietetic service delivery in rural northern New South Wales. PARTICIPANTS Forty key informants including past and present dietitians, dietetic managers and health service managers were recruited, of these a subset of 15 interviews included discussion or comments about private practice in rural areas. MAIN OUTCOMES MEASURES Themes identified from the interview transcripts, Medicare enhanced primary care consultation data and public/private dietetic staffing levels from document searches. RESULTS Private practice staffing ranged between 0% and 26% of the dietetic workforce across the six sites in 2006. Themes relating to the drivers and barriers for private practice were identified: financial factors, job satisfaction, opportunities for private practice and establishing private practice. CONCLUSIONS There is an opportunity for growth of private practice to meet the gap in public dietetic services in rural areas.

Dietary intakes and anthropometric measures of Indigenous Australian women and their infants in the Gomeroi gaaynggal cohort.

Indigenous Australians continue to experience disparities in chronic diseases, many of which have nutrition-related trajectories. Optimal nutrition throughout the lifespan is protective for a number of adverse health outcomes, however little is known about current dietary intakes and related anthropometric outcomes of Indigenous women and their infants. Research is required to identify nutrition issues to target for health promotion activities. The Gomeroi gaaynggal programme is an ongoing, prospective cohort of pregnant Indigenous Australian women and their children. A cross-sectional examination of postnatal dietary intakes and anthropometric outcomes of mothers and children are reported. To date, 73 mother-child dyads have participated postpartum. Breastfeeding initiation was 85.9% and median (interquartile range) duration of any breastfeeding was 1.4 (0.5-4.0) months. Infants were introduced to solid foods at 5.0 months (4.0-6.0) and cows milk at 12.0 (10.0-13.0) months. At 12 months postpartum, 66.7% of women were overweight or obese, 63.7% at 2 years. Compared with recommendations, reported median maternal nutrient intakes from 24-h recall were low in fibre, folate, iodine, calcium, potassium and vitamin D and high in proportions of energy from total and saturated fat. Limitations of this study include a small sample size and incomplete data for the cohort at each time point. Preliminary data from this ongoing cohort of Indigenous Australian women and children suggest that women may need support to optimize nutrient intakes and to attain a healthy body weight for themselves and their children.

Factors Associated with Effective Nutrition Interventions for Pregnant Indigenous Women: A Systematic Review

INTRODUCTION Indigenous people continue to experience health disparities relative to non-Indigenous populations. Interventions to improve nutrition during pregnancy in these groups may improve health outcomes for mothers and their infants. The effectiveness of existing nutrition intervention programs has not been reviewed previously. OBJECTIVE The objective was to identify interventions targeting improving nutrition-related outcomes for pregnant Indigenous women residing in Organisation for Economic Co-operation and Development countries, and to identify positive factors contributing to successful programs. METHODS Thirteen electronic databases were searched up until October 2015. Key words identified studies intervening to improve nutrition-related outcomes for pregnant Indigenous women. Two reviewers assessed articles for inclusion and study quality and extracted data. Only studies published in English were included. Data were summarized narratively. RESULTS Abstracts and titles were screened (n=2,566) and 315 full texts were reviewed for eligibility. This review included 27 articles from 20 intervention programs from Australia, Canada, and the United States. The most prevalent measurable outcomes were birth weight (n=9) and breastfeeding initiation/duration (n=11). Programs with statistically significant results for these outcomes employed the following nutrition activities: individual counseling/education (n=8); delivery by senior Indigenous woman (n=2), peer counselor (n=3), or other Indigenous health worker (n=4); community-wide interventions (n=2); media campaigns (n=2); delivery by non-Indigenous health professional (n=3); and home visits (n=3). CONCLUSIONS Heterogeneity of included studies made it challenging to make firm recommendations regarding program success. Authors of included studies recommended community consultation be included when designing studies and working with communities at all stages of the research process. Individualized counseling/education can contribute to successful program outcomes, as can the use of Indigenous workers to deliver program content. Limitations of some studies included a lack of details on interventions and the use of nonrandom control groups. Future studies should include detailed descriptions of intervention components and include appropriate evaluation protocols.

Contribution of university departments of rural health to rural health research: an analysis of outputs

OBJECTIVE To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. DESIGN AND SETTINGS Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. MAIN OUTCOME MEASURES In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. RESULTS Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82); most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56%; n = 102) of the articles addressed rural health issues; Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1-19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2-5 universities/organisations but only 5% of articles included an author from more than one UDRH. CONCLUSIONS Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.Objective To assess the research contribution of eleven University Departments of Rural Health (UDRH) which were established as a rural health workforce program in the late 1990s through analysis of peer-reviewed journal output. Design and settings Descriptive study based on validated publications from publication output reported in annual key performance indicator (KPI) reports to the Commonwealth Department of Health, Australia. Main outcome measures In addition to counts and the type of publications, articles were examined to assess fields of research, evidence of research collaboration, and potential for influencing policy. Funding acknowledgement was examined to provide insight into funding sources and research consultancies. Results Of the 182 peer-reviewed articles, UDRH staff members were the first and corresponding author for 45% (n = 82); most (69%, n = 126) were original research. Most publications examined included Australian data only (80%, n = 101). Over half (56%; n = 102) of the articles addressed rural health issues; Aboriginal health was the main subject in 14% (n = 26). Thirty-three articles (18%) discussed the policy implications of the research and only half (51%, n = 93) of the articles listed sources of funding. Number of authors per article ranged from 1–19, with a mean of 5 (SD = 3.2) authors per article, two-thirds of articles included authors from 2–5 universities/organisations but only 5% of articles included an author from more than one UDRH. Conclusions Staff from UDRHs are regularly publishing peer-reviewed articles, and research productivity demonstrated cooperation with external partners. Better collaboration between UDRH staff and others may help increase the quality and value of Australian rural health research.

Development and characteristics of the dietetic workforce in six rural sites in NSW

Best practice guidelines for weight management often fail to identify the depth and frequency of follow up and reinforcement of behaviour change. 152 obese adults were randomised to one of three iso-energetic diets. Participants were followed up monthly in person for 6 months and at 9 and 12 months, with twice-monthly telephone support during the 6 month intervention period. Dietary compliance was assessed at each phone call. Overall dietary compliance was defined as compliant on >6 phone calls. Participants were considered successful if they maintained >5% weight loss from baseline at 3, 6 and 12 months inclusive. Intention to treat repeated measures General Linear Model analysis showed successful participants accessed more phone calls than those who lost 50% phone calls (overall compliant 98% vs. not compliant 55%; overall compliant 100% vs. not compliant 43%, respectively) (χ2 = 45.5, p < 0.001; χ2 = 50.7, p < 0.001). Results suggest that professional support may not directly produce weight loss success but is associated with better outcomes. More research is required to further inform best practice guidelines.We investigated the interaction between dietary quality and television viewing time with abnormal glucose metabolism (AGM; impaired fasting glucose, impaired glucose tolerance or newly diagnosed diabetes). Data were from a population-based cross-sectional study (AusDiab) including 4,754 men and 5,849 women ≥25 years without diagnosed diabetes. Diet was measured by food frequency questionnaire, scored using the Diet Quality Index-Revised, and categorised as high, medium or low. Television time was categorised as low (≤14 hours/week) or high (>14 hours/week). Logistic regression models adjusting for known confounding variables, including physical activity and waist circumference, were constructed separately for men and women. For men and women, the odds of having AGM was 1.32 (95% CI 1.03–1.64, p = 0.030) in those with low diet quality compared to those with high diet quality. The interaction between television viewing time and diet quality was significant only for women. In women, relative to those with low television time and high diet quality, the odds ratio of having AGM was 1.74 (95% CI 1.20–2.51, p = 0.004) in those with low television time and low diet quality, 1.40 (95% CI 1.07–1.84, p = 0.015) in those with high television time and moderate diet quality and 2.52 (95% CI 1.62–3.92, p < 0.001) in those with high television time and low diet quality. The odds ratios for low television time and moderate diet quality (1.11, 95% CI 0.79–1.54) and high television time and high diet quality (1.07, 95% CI 0.77–1.48) were not significant. High diet quality, together with reduced sedentary time, is important for reducing the risk of AGM.